Listening to music with personal listening devices: monitoring the noise dose using a smartphone application

Risk-taking propensity as a risk factor for noise-induced hearing loss in the general population

OBJECTIVES

To examine general risk propensity in relation to perceptions of noise, risk behaviour, and hearing loss in the general population.

DESIGN

Participants completed an online survey using the Amazon Mechanical Turk crowdsourcing platform.

STUDY SAMPLE

The sample comprised 1274 adults from the United States.

RESULTS

Higher general risk propensity was associated with an increased likelihood to engage in noise-risk behaviours. Lower general risk propensity was associated with increased knowledge of noise risks and an increased perception of noise as risky. The frequency of self-reported exposures to hazardous noise resulted in estimated annual noise doses exceeding standard hazard limits in 40% of the surveyed population.

CONCLUSIONS

Results revealed limited knowledge of the risks and associated health consequences of noise exposure in the general population Results of this study suggest a high rate of self-exposure to hazardous noise by the general population. Those with higher general risk propensity are more likely to engage in risky noise behaviour. Risky noise behaviour is associated with age, gender, race, ethnicity, and general risk propensity. Intervention programs to modify risky noise behaviour in the general population should focus on both increasing knowledge and establishing accurate perceptions of risk.

Attitudes towards hearing, hearing loss, and hearing protection in university students

OBJECTIVE

Young adults are at risk for hearing loss caused by exposure to loud music. Intervention at this stage provides opportunities to support lifelong hearing protection use. This study explores attitudes related to hearing, hearing loss, and hearing protection among university students.

DESIGN

Qualitative interview design, supplemented by quantitative questionnaire data.

STUDY SAMPLE

18 university students, aged 18-24 years.

RESULTS

Students were uncertain about mechanisms of noise-induced hearing loss, did not feel vulnerable to permanent hearing damage from loud music, were unconvinced of hearing protection efficacy, and reported barriers to hearing protection use. Students emphasised the positive effects of loud music and reported an increased likelihood of using hearing protection were it used by peers. Music students appeared more aware of the negative effects of loud music exposure. Students reported conflicting attitudes regarding government regulation of hearing protection use.

CONCLUSION

Young adults require education about hearing protection from multiple, credible sources and need to understand the mechanisms behind noise-induced hearing loss in a way that makes it of high personal relevance.

Prevalence and global estimates of unsafe listening practices in adolescents and young adults: a systematic review and meta-analysis

INTRODUCTION

This study aimed to determine the prevalence of unsafe listening practices from exposure to personal listening devices (PLDs) and loud entertainment venues in individuals aged 12-34 years, and to estimate the number of young people who could be at risk of hearing loss from unsafe listening worldwide.

METHODS

We conducted a systematic review and meta-analysis to estimate the prevalence of unsafe listening practices from PLDs and loud entertainment venues. We searched three databases for peer-reviewed articles published between 2000 and 2021 that reported unsafe listening practices in individuals aged 12-34 years. Pooled prevalence estimates (95% CI) of exposed populations were calculated using random effects models or ascertained from the systematic review. The number of young people who could be at risk of hearing loss worldwide was estimated from the estimated global population aged 12-34 years, and best estimates of exposure to unsafe listening ascertained from this review.

RESULTS

Thirty-three studies (corresponding to data from 35 records and 19 046 individuals) were included; 17 and 18 records focused on PLD use and loud entertainment venues, respectively. The pooled prevalence estimate of exposure to unsafe listening from PLDs was 23.81% (95% CI 18.99% to 29.42%). There was limited certainty (p>0.50) in our pooled prevalence estimate for loud entertainment venues. Thus, we fitted a model as a function of intensity thresholds and exposure duration to identify the prevalence estimate as 48.20%. The global estimated number of young people who could be at risk of hearing loss from exposure to unsafe listening practices ranged from 0.67 to 1.35 billion.

CONCLUSIONS

Unsafe listening practices are highly prevalent worldwide and may place over 1 billion young people at risk of hearing loss. There is an urgent need to prioritise policy focused on safe listening. The World Health Organization provides comprehensive materials to aid in policy development and implementation.

A Smartphone Application and Education Program for Hearing Health Promotion in High School Teenagers

OBJECTIVES

To assess knowledge retention after video-based hearing health education and measure headphone listening behavior change using a novel smartphone application.

METHODS

In this prospective longitudinal study, students participated in video-based hearing health education and hearing screening sessions. Hearing health knowledge was assessed in students and parents after 6 weeks. A novel smartphone application was created to measure daily noise exposure based on volume settings with headphone use and to display the National Institute for Occupational Safety and Health (NIOSH) noise doses with alerts for cumulative daily doses nearing the maximum.

RESULTS

Seventy-six teenage students and parents participated. Eighty three percent of participants identified as a racial or ethnic minority and 66% were of low-income socioeconomic status. Hearing health knowledge was retained in students 6 weeks after education and parents' knowledge improved from baseline. The smartphone app was installed on 12 student phones, and 25% of days monitored exhibited noise doses that exceeded the NIOSH maximum. App use for at least 10 days by nine students showed a significant reduction in average daily noise dose and time spent at the highest volume settings during the second-half of app use.

CONCLUSIONS

Video-based hearing health education with knowledge question reinforcement was associated with knowledge retention in students and improved parental attitudes and knowledge about hearing conservation. A smartphone app with a real-time display of headphone cumulative noise exposure dose identified at-risk students. The integration of hearing health education, hearing screening, and digital health tools has promised to promote positive behavior changes for long-term hearing conservation.

LEVEL OF EVIDENCE

4 Laryngoscope, 2022.

Encouraging Hearing Loss Prevention in Music Listeners Using Personalized Technology: Questionnaire Study

Background

Noise-induced hearing loss (NIHL) affects millions of people despite being almost completely preventable. For recreational music listening through personal listening equipment (such as earbuds), it seems that listeners do not yet have a way to accurately assess their risk of developing hearing loss and prevent it accordingly.

Objective

The aim of this study is to analyze the perceived utility of a hypothetical device that encourages NIHL prevention based on listeners’ exposure to noise and to determine the most effective methods of such encouragement. Here, we describe 3 different potential NIHL risk notification method types, as follows: auditory, external visual, and visual.

Methods

An open, web-based survey was created on Google Forms, and the link was posted to Amazon’s Mechanical Turk as well as music-related Reddit communities. The survey was designed to gauge each respondent’s self-assessed NIHL awareness, willingness to lower their audio if reminded, and NIHL risk notification type preference. The likelihood of a specific notification type to encourage NIHL prevention among its users was based on the average of each user’s responses to 2 survey questions. Data collection started on July 13, 2020, and ended on July 17, 2020.

Results

Of the 116 respondents, 92 (79.3%) reported having prior awareness about NIHL; however, 60 (51.7%) described doing nothing to prevent it despite 96 (82.8%) feeling a moderate, high, or extreme risk of developing NIHL. Of those who already prevented NIHL, 96% (53.5/56) described using estimates to guide their prevention instead of using data. A Kruskal-Wallis test corrected for ties showed that despite the visual NIHL risk notification type being selected by the highest number of participants (84/116, 72.4%), the auditory type had a significantly higher (H1=6.848; P=.03) average percentage likelihood of encouraging NIHL prevention (62%, SD 24%) among the 40 respondents who chose it, with a median likelihood of 56% (95% CI 50%-75%). The visual type’s average likelihood was 50% (SD 28.1%), with a median of 50% (95% CI 37.5%-56.3%). Regardless of the NIHL risk notification type, 69% (80/116) of respondents were not opposed to using NIHL risk notifications and lowering their audio volume accordingly.

Conclusions

The hypothetical device detailed here was thought to be useful because most respondents (82.8%, 96/116) felt an extreme to moderate risk of developing NIHL and such a device could provide accurate data to those who currently use estimates to prevent NIHL, and most respondents were willing to act on NIHL risk notifications. The most effective NIHL risk notification type seemed to be the auditory type, but many aspects of this study need further research to determine which implementation method should reach the public.

The association of sociodemographic factors and risk behavior with unsafe use of personal listening devices in adolescents

Many young people are potentially at risk of noise-induced hearing loss due to unsafe use of personal listening devices. The aim of this cross-sectional study was to examine the association of sociodemographic factors and risk behavior with unsafe use of personal listening devices in adolescents to identify a target group for prevention. A smartphone application was developed to objectively measure music listening habits among 314 adolescents with a mean age of 13 years and 7 months (SD ±5 months). Listening habits were characterized as safe or unsafe based on the weekly noise dose. Data on sociodemographic factors and traditional health risk behaviors were obtained by questionnaires. Within the study group, 10.5% of the participants exceeded the 50%, and 4.8% the 100% recommended weekly noise dose. Adolescents with a lower socioeconomic status were more likely to engage in unsafe listening habits as compared to adolescents with a higher socioeconomic status. Additionally, risk behavior was associated with higher odds of having unsafe listening habits as compared to no risk behavior. Age, sex and educational levels were not significantly associated with unsafe listening habits. The findings of the present study indicate that interventions to promote safe listening habits should target adolescents with a lower socioeconomic status and higher risk behavior. Future research is needed to investigate how these adolescents can be motivated to adopt safe listening habits.

Objective Measurement of Listening Device Use and Its Relation to Hearing Acuity

Objectives

To examine whether adolescents exceed recommended noise exposure limits when using personal listening devices (PLDs) and to investigate the relationship between objectively measured PLD use and hearing thresholds

Study Design

Cross-sectional study.

Setting

This study was embedded within an ongoing prospective birth cohort study in Rotterdam, the Netherlands. Data were collected from May 2017 to September 2019.

Methods

A smartphone application was developed to measure daily noise exposure from PLDs. Listening habits were monitored among 314 adolescents with a mean age of 13 years 7 months (SD, 5 months), of whom 51.6% were male. Hearing acuity was measured by pure tone audiometry, and tympanometry was performed in both ears.

Results

Within the study group, 2.2% adolescents exceeded the recommended daily noise dose (85 dBA as an 8-hour time-weighted average) among all days when the application was active and 9.9% when among only the listening days. No significant correlation was found between the daily noise dose from PLDs and pure tone thresholds.

Conclusions

The majority of adolescents exhibited listening habits that could be considered safe. As noise-induced hearing loss develops slowly over time, it could be that the effects of PLD use on hearing are not evident yet in this young population with a relatively short duration of PLD use.

Sound-level Monitoring Earphones With Smartphone Feedback as an Intervention to Promote Healthy Listening Behaviors in Young Adults

OBJECTIVES

More than a billion adolescents and youngsters are estimated to be at risk of acquiring recreational noise-induced hearing loss (RNIHL) due to the unsafe use of personal audio systems. RNIHL is preventable; therefore, the present study aimed to determine (i) the accuracy and reliability of dbTrack (Westone) sound-level monitoring earphones and (ii) the effect of sound-level monitoring earphones with smartphone feedback and hearing-health information as an intervention to promote healthy listening behaviors in young adults.

DESIGN

The study consisted of two phases: the first phase investigated the accuracy and reliability of dbTrack sound-level monitoring earphones. Accuracy was determined by comparing earphone measurements to sound level meter measurements. Intradevice reliability was determined by comparing earphone measurements during test-retest conditions. Nineteen participants were recruited through convenience sampling to determine within-subject reliability by comparing in-ear sound levels measured by the earphones during test-retest conditions. For the second phase of the study, a single-group pretest-posttest design was utilized. Forty participants, recruited through snowball sampling, utilized the sound-level monitoring earphones with the accompanying dbTrack smartphone application for 4 weeks. The application's smartphone feedback was disabled during the first 2 weeks (pretest condition) and enabled during the last 2 weeks (posttest condition). Average daily intensities, durations, and sound dosages measured during pre- and posttest conditions were compared.

RESULTS

Phase 1 dbTrack earphone measurements were within 1 dB when compared with sound level meter measurements. Earphones were also within 1 dB in repeated measures across earphones and across participants. Phase 2 posttest average daily intensity decreased by 8.7 dB (18.3 SD), duration decreased by 7.6 minutes (46.6 SD), and sound dose decreased by 4128.4% (24965.5% SD). Differences in intensity and sound dose were significantly lower with a small and medium effect size, respectively.

CONCLUSIONS

This study's preliminary data indicate that dbTrack (Westone) sound-level monitoring earphones with a calibrated in-ear microphone can reliably and accurately measure personal audio systems sound exposure. Preliminary results also suggest that feedback on sound exposure using the accurate sound-level monitoring earphones with the accompanying dbTrack application can potentially promote safe listening behavior in young adults and reduce the risk of acquiring an RNIHL.

A smartphone application to objectively monitor music listening habits in adolescents : Personal listening device usage and the accuracy of self-reported listening habits

Background

Listening to music through personal listening devices (PLDs) has become more prevalent during last decades. The aim of this study was to evaluate music listening habits through PLDs in adolescents with a smartphone application, and to assess the accuracy of self-reported listening habits.

Methods

This study was embedded in the Generation R Study, a population-based prospective birth cohort in Rotterdam, the Netherlands. A smartphone application for Android operating systems was developed to objectively monitor music listening habits for a period of 35 days. A postal questionnaire was used to subjectively assess listening habits. The level of agreement between the objectively measured and self-reported listening habits were evaluated using weighted kappa coefficients. Data were collected from May 2017 to March 2019.

Results

A total of 311 adolescents aged 12 to 15 years were included, of whom 237 (76.2%) completed the postal questionnaire. The results of the smartphone application showed that the median listening frequency was 2.1 days a week (IQR 1.0–3.4), the median listening time 21.1 min a day (IQR 9.1–53.7), and the mean listening level 54.5% (SD 18.1%). There was a slight to fair agreement between the objectively measured, and self-reported listening habits according to the weighted kappa coefficients (k = 0.179 to 0.364).

Conclusions

The results of the current study suggest that self-reported measures of listening habits are not always accurate. We consider a smartphone application to monitor listening habits of added value in future research investigating the possible damaging effects of PLDs on hearing acuity.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40463-020-00488-5.

Possibilities, Problems, and Perspectives of Data Collection by Mobile Apps in Longitudinal Epidemiological Studies: Scoping Review

Background

The broad availability of smartphones and the number of health apps in app stores have risen in recent years. Health apps have benefits for individuals (eg, the ability to monitor one’s health) as well as for researchers (eg, the ability to collect data in population-based, clinical, and observational studies). Although the number of health apps on the global app market is huge and the associated potential seems to be great, app-based questionnaires for collecting patient-related data have not played an important role in epidemiological studies so far.

Objective

This study aims to provide an overview of studies that have collected patient data using an app-based approach, with a particular focus on longitudinal studies. This literature review describes the current extent to which smartphones have been used for collecting (patient) data for research purposes, and the potential benefits and challenges associated with this approach.

Methods

We conducted a scoping review of studies that used data collection via apps. PubMed was used to identify studies describing the use of smartphone app questionnaires for collecting data over time. Overall, 17 articles were included in the summary.

Results

Based on the results of this scoping review, there are only a few studies that integrate smartphone apps into data-collection approaches. Studies dealing with the collection of health-related data via smartphone apps have mainly been developed with regard to psychosomatic, neurodegenerative, respiratory, and cardiovascular diseases, as well as malign neoplasm. Among the identified studies, the duration of data collection ranged from 4 weeks to 12 months, and the participants’ mean ages ranged from 7 to 69 years. Potential can be seen for real-time information transfer, fast data synchronization (which saves time and increases effectivity), and the possibility of tracking responses longitudinally. Furthermore, smartphone-based data-collection techniques might prevent biases, such as reminder bias or mistakes occurring during manual data transfers. In chronic diseases, real-time communication with physicians and early detection of symptoms enables rapid modifications in disease management.

Conclusions

The results indicate that using mobile technologies can help to overcome challenges linked with data collection in epidemiological research. However, further feasibility studies need to be conducted in the near future to test the applicability and acceptance of these mobile apps for epidemiological research in various subpopulations.

Use of Personal Listening Devices and Knowledge/Attitude for Greater Hearing Conservation in College Students: Data Analysis and Regression Model Based on 1009 Respondents

Given the concern regarding increased hearing loss in young people who use personal listening devices (PLDs), the present study analyzes the experience of PLDs among college students to identify their knowledge of and attitude toward hearing conservation. It also explains their relationship between knowledge of hearing loss and attitude-related hearing conservation as a questionnaire response using a regression model. A total of 1009 Korean college students responded to an online questionnaire. As a survey tool, the Personal Listening Device and Hearing Questionnaire was adapted as a Korean version with 78 modified items under 9 categories. Using principal component analysis, specific factors were extracted, and their relationships and paths were confirmed using multiple regression analysis. The results of the knowledge category of the questionnaire indicate that most respondents knew how to maintain healthy hearing and understood the signs of hearing loss. Regardless, many college students habitually use PLDs at high levels in noisy environments; they do not recognize how to prevent hearing loss. Even though they continue their current use pattern for PLDs, they also had a positive attitude toward receiving more information about hearing conservation. According to the regression model, the students' self-reported hearing deficits were due to the volume rather than the frequent use. Interestingly, knowledge about hearing loss may encourage students to develop a positive attitude toward reasonable restriction of PLD use. When PLD users have detailed knowledge about the hearing loss provided by professionals, we believe that most will avoid serious hearing problems and its risks and maintain a judicious attitude toward their own conservation.

Analysis of Output Levels of an MP3 Player: Effects of Earphone Type, Music Genre, and Listening Duration

Background and Objectives

To prevent noise induced hearing losses caused by listening to music with personal listening devices for young adults, this study was aimed to measure output levels of an MP3 and to identify preferred listening levels (PLLs) depending on earphone types, music genres, and listening durations.

Subjects and Methods

Twenty-two normal hearing young adults (mean=18.82, standard deviation=0.57) participated. Each participant was asked to select his or her most PLLs when listened to Korean ballade or dance music with an earbud or an over-the-ear earphone for 30 or 60 minutes. One side of earphone was connected to the participant’s better ear and the other side was connected to a sound level meter via a 2 or 6 cc-couplers. Depending on earphone types, music genres, and listening durations, loudness A-weighted equivalent (LAeq) and loudness maximum time-weighted with A-frequency sound levels in dBA were measured.

Results

Neither main nor interaction effects of the PLLs among the three factors were significant. Overall output levels of earbuds were about 10-12 dBA greater than those of over-the-ear earphones. The PLLs were 1.73 dBA greater for earbuds than over-the-ear earphones. The average PLL for ballad was higher than for dance music. The PLLs at LAeq for both music genres were the greatest at 0.5 kHz followed by 1, 0.25, 2, 4, 0.125, 8 kHz in the order.

Conclusions

The PLLs were not different significantly when listening to Korean ballad or dance music as functions of earphone types, music genres, and listening durations. However, over-the-ear earphones seemed to be more suitable to prevent noise induce hearing loss when listening to music, showing lower PLLs, possibly due to isolation from the background noise by covering ears.